Severely deformed spine hinders toddler’s breathing

Thursday, 12 l 05 l 2011 Source: Mind Your Body; The Straits Times

By: Joan Chew

An abnormally curved spine isenough of a worry, but somechildren born with scoliosiscarry an extra burden of beingunable to breathe properly too.One or two in every 100patients with congenital scoliosis willhave a spine that is so twisted that thechest and rib cage are compressed,preventing the lungs from working orgrowing normally.

But a new procedure introduced in KKWomen’s and Children’s Hospital (KKH)last August spells hope for such patients,said Dr Kevin Lim, a senior consultant atits department of orthopaedic surgery.In the three- to four-hour procedure, aVertical Expandable Prosthetic TitaniumRib (VEPTR, pronounced “vep-ter”) is fixedto the back of the rib cage to prevent itfrom collapsing any further.The adjustable titanium rod is curved to fit theback of the chest andspine.Hooks on both ends ofthe device are attachedto two ribs, or to a riband the pelvis, or to a riband the spine.

Three young patientshave undergone theprocedure at KKH, saidDr Lim, who is the firstdoctor in the hospital to be trained in it.The youngest, Sririta Phikun, was only14 months old when she had it done lastAugust, while the other two were two andfour years old.The procedure has been used in theUnited States, Europe, Australia, NewZealand, South Korea and Taiwan.Sririta, who turns two next Thursday,had a spine curved in the shape of an “S”when Dr Lim first saw her in 2009. Shewas only a few months old then.A big part of the curve was in herchest, compressing it severely.Many of her ribs were also fused frombirth and some of her vertebrae were onlyhalf-formed.With her lungs trapped in such aconfined space, their capacity was only70 per cent that of a normal child, Dr Limestimated.They would have been unable to growproperly and she would always be unableto exert herself without becomingbreathless, he said.

Given her curved spine, she would alsobe unlikely to top 1.25m by the time shewas 20 years old, he added.He separated Sririta’s fused ribs andimplanted two rods – one on each side ofher body – to hold the ribs apart.Each was about 15 to 20cm long, withone end hooked onto her ribcage and theother to her pelvic bone.Dr Lim said the treatment allows therib cage to grow larger in volume and alarger chest allows more room for thelungs to expand and grow.A longer, straighter chest would alsomitigate the spinal curvature, he said.

Every six to nine months, Sririta willhave surgery again, until she is about 13or 14 years old, to lengthen the rods to“expand the chest a little bit more,allowing for further lung growth”, he said.After that age, she may have spinalfusion surgery to fix her spine in place.The drawback for the VEPTR procedureis its prohibitive cost. Dr Tan Chong Tien, an orthopaedicsurgeon at Mount Elizabeth MedicalCentre, said he has offered it to threepatients, but none chose to proceedbecause it could cost $50,000.

At KKH, it costs about $25,000 to$40,000. A titanium rod alonecosts $15,000 to $50,000.MediShield, theGovernment’s health-insurancescheme covering seriousillnesses, cannot be used topay for the procedure as thescheme does not covercongenital conditions.But earlier this month,Health Minister Khaw BoonWan said the Health Ministry isstudying the feasibility of extendingMediShield to cover more illnesses,including mental and congenitalconditions.

Sririta’s father, cargo assistant KongKok Keong, 34, had help from the KKHHealth Endowment Fund and a privatecharity to cover more than 85 per cent ofthe cost of his daughter’s initial surgeryand hospitalisation, which came up toabout $26,000.KKH declined to reveal how the othertwo patients paid for their operations.The surgery to lengthen Sririta’simplants cost approximately $1,100.

This was largely covered by Medifund,a national endowment fund to help theneedy pay their medical bills.Mr Kong said he was devastated tolearn about his younger daughter’s spinalproblem, which he had never heard of.He has not revealed all the details ofSririta’s condition to her Thai mother,Ms Tip Phikun, 27, so as not to worry herunduly.Now Sririta will have a shot at growingup more normally, like her sister, who isfour years old and healthy.Mr Kong said in Mandarin: “Surgery isthe only way to help Sririta and I’mthankful for KKH’s help.”

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